Kenneth Levy

Kenneth Levy
Pennsylvania State University | Penn State · Department of Psychology

Doctor of Philosophy

About

217
Publications
327,278
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10,314
Citations
Additional affiliations
January 2012 - present
January 2011 - present
University of Georgia
January 2009 - December 2012
Long Island University

Publications

Publications (217)
Chapter
It is argued that the diagnosis of borderline personality disorder (BPD) is an important clinical concept that has important clinical utility. Factor analytic studies show that its symptoms are regularly associated with each other to form a coherent construct. This chapter provides an overview of BPD, its clinical presentation, and the treatment ap...
Preprint
Interpersonal theory organizes social behavior along dominant (vs. submissive) and warm (vs. cold) dimensions. There is a growing interest in assessing these behaviors in naturalistic settings to maximize ecological validity and to study dynamic social processes. Studies that have assessed interpersonal behavior in daily life have primarily relied...
Article
Full-text available
In 2000, Taylor and colleagues proposed the “tend-and-befriend” hypothesis, which posits that women utilize an alternative stress response to fight-or-flight, promoting the survival of themselves and their offspring (tend) through the formation of groups (befriend). Although there has been support for this hypothesis since, Levy and colleagues (201...
Chapter
Treatment approaches for borderline personality disorder (BPD) derive from a range of traditions and theoretical orientations, oftentimes considered to be competing or mutually exclusive. In this chapter we describe the major psychotherapy approaches for treating BPD and examine the evidence from both randomized controlled trials and meta-analyses....
Article
Chronic emptiness in borderline personality disorder (BPD) has received little empirical attention. We sought to examine basic properties of a single chronic emptiness item, including prevalence, reliability, validity, the relation of the emptiness item to other BPD criteria, and measures of personality. Undergraduates enrolled in psychology course...
Article
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Objective: The capacity for understanding mental states (reflective functioning; RF) is considered essential for self-growth, social learning, and emotion regulation. Impaired RF is thought to play a central role in borderline personality disorder (BPD). We examined whether asking patients to consider mental states in-session has a down-regulatory...
Article
Background Most people will experience a traumatic event in their lifetime, but only a subset (<10%) will develop posttraumatic stress disorder (PTSD). Objective To facilitate prevention and intervention of PTSD, it is important to understand how risk and resilience factors interact with one another to explain individual differences in risk for PT...
Article
Full-text available
Personality disorders (PDs) are relatively common, especially in clinical settings. A number of evidence-based treatments are now available, especially for borderline personality disorder (BPD). However, little is known about the relevant training available to doctoral students in clinical and counseling psychology. In the current study, data were...
Article
To date, prominent theories still disagree on whether the pathological grandiosity that underlies narcissism stems from a defensive, compensatory process in response to insecurity or from years of unjustified overvaluation during formative stages of development. Across two studies, we introduce a novel method to test these theories by examining vis...
Chapter
In this chapter, we discuss the state of the science regarding the measurement of implicit personality (i.e., the elements of personality that are not accessible via conscious introspection). Optimal measurement of implicit personality necessitates a strong underlying psychological theory combined with indirect measurement that is resilient to dish...
Article
Beginning with its inception in DSM‐III, NPD has been characterized by a pervasive pattern of grandiosity, feeling privileged, entitled, and expecting preferential treatment, as well as displaying an exaggerated sense of self‐importance, and showing arrogant and haughty behaviors or attitudes. In contrast to DSM's predominantly grandiose emphasis,...
Article
Borderline personality disorder (BPD) is a highly prevalent, chronic, and debilitating disorder characterized by instability in one's sense of self, others, and mood. This instability is expressed as emotional lability, impulsivity, interpersonal dysfunction, angry outbursts, suicidality, and non‐suicidal self‐injury. One in 10 patients with BPD wi...
Article
Beginning with its inception in DSM‐III, NPD has been characterized by a pervasive pattern of grandiosity, feeling privileged, entitled, and expecting preferential treatment, as well as displaying an exaggerated sense of self‐importance, and showing arrogant and haughty behaviors or attitudes. In contrast to DSM's predominantly grandiose emphasis,...
Article
Borderline personality disorder (BPD) is a highly prevalent, chronic, and debilitating disorder characterized by instability in one's sense of self, others, and mood. This instability is expressed as emotional lability, impulsivity, interpersonal dysfunction, angry outbursts, suicidality, and non‐suicidal self‐injury. One in 10 patients with BPD wi...
Article
Full-text available
Borderline personality disorder (BPD) involves instability in self-concept, emotions, and behavior. However, the dynamic, longitudinal relations among BPD symptoms and between these symptoms and other problematic emotional experiences are poorly understood. It is also unclear whether these dynamics are the same across persons (including across diag...
Article
Full-text available
Experience sampling methods are widely used in clinical psychology to study affective dynamics in psychopathology. The present study examined whether affect ratings (valence and arousal) differed as a function of assessment schedule (signal- versus event-contingent) in a clinical sample and considered various approaches to modeling these ratings. A...
Article
Full-text available
This study investigates the “tend-and-befriend” hypothesis proposed in 2000 by Taylor and colleagues, which posits that women utilize an alternative stress response to fight-or-flight, ensuring the survival of themselves and their offspring (tend) through the formation of groups (befriend). In contrast, we propose that, while sexes may differ in th...
Article
Full-text available
Purpose of Review In this article, we describe the goals of transference-focused psychotherapy (TFP), its indications, underlying theory, and its broad structure and techniques. We summarize the current empirical support for TFP in regard to symptom and personality change. Lastly, we discuss recent developments and applications in TFP. Recent Find...
Article
Childhood maltreatment is one of many risk factors for borderline personality disorder (BPD). However, not all individuals with BPD report histories of childhood maltreatment. Therefore, it is necessary to identify factors that contextualize the relation between childhood maltreatment and BPD features. With its emphasis on the developmental origins...
Article
Full-text available
Objective: To examine conformity to prototypical therapeutic principles and its relation with change in reflective functioning in 3 treatments for borderline personality disorder (BPD). Method: Early phase videotaped sessions from a randomized-controlled trial of year-long transference-focused psychotherapy (TFP; n = 27), dialectical behavior th...
Article
Full-text available
Objective: Borderline personality disorder (BPD) is serious, prevalent, and symptomatically heterogeneous. Identifying distinct phenotypes of BPD features promises useful diagnostic and treatment implications. Although a series of subtyping studies exist, only two have examined BPD symptom configurations while taking into account BPD severity. We u...
Chapter
Attachment style describes characteristic patterns of relating to close others and has important implications for psychotherapy. This chapter provides an original meta-analysis of 36 studies (3,158 patients) to determine the association of patient attachment with psychotherapy outcome. Patients with secure attachment pretreatment show better psycho...
Article
Objective: To examine if alliance dynamics are affected by tailoring the therapeutic relationship to the individual patient in brief psychotherapy of borderline personality disorder. Method: Sixty patients were randomized to 10-session Good Psychiatric Management (GPM-BV) or GPM combined with Motive-Oriented Therapeutic Relationship techniques (MOT...
Chapter
Transference-focused psychotherapy (TFP) is a psychodynamic, empirically supported psychotherapy for personality disorders based on Otto Kernberg's object relations theory. Case formulation and treatment planning in TFP is based on the patient's level of personality organization (i.e., capacity for reality testing, predominant defence mechanisms, a...
Article
Findings from randomized controlled trials and meta-analyses suggest that there are several efficacious treatments for borderline personality disorder, including those based on cognitive behavior theories and psychodynamic theories. In addition, there are generalist and adjunctive approaches. These treatments and the corresponding evidence associat...
Article
Bowlby’s attachment theory describes characteristic patterns of relating to close others and has important implications for psychotherapy. Attachment patterns have been characterized as secure (healthy interdependence with others), anxious (overdependence on others), and avoidant (difficulty relying on others). We update a previous meta‐analysis to...
Article
Full-text available
In this paper, we provide an overview of Bowlby’s theory of attachment, its revisions, and related constructs, and describe how attachment may underlie many of the processes of psychotherapy. Modern psychotherapy research, plagued by the omnipresent “dodo bird” that has consistently determined that most psychotherapy modalities appear to have simil...
Chapter
Full-text available
Psychotherapy for personality disorders – a group of disorders characterized by long-standing patterns of intra- and interpersonal difficulties – tends to be highly structured, integrative, and often long-term, with special attention made to the relationship between therapist and patient.
Article
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The founding members of the Coalition for Psychotherapy Parity present Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. These guidelines support access to psychotherapy as prescribed by the clinician without arbitrary limitations on duration or frequency. The au...
Article
Deficits in identity as well as negative affect have been shown to predict self-injurious and suicidal behaviors in individuals with borderline personality disorder (BPD). However, less is known about the interactive effects of these two predictors. We examined the moderating effect of a particular component of identity, self-concept, on the relati...
Article
In this study, the authors explored whether attachment insecurity moderates the effects of adverse childhood experiences on stress reactivity in the context of borderline personality disorder (BPD). Participants were 113 women (39 with BPD, 15 with some BPD criteria present, 59 without any BPD symptoms) who participated in the Trier Social Stress T...
Article
Transference-focused psychotherapy (TFP) is a manualized evidence-based treatment for borderline and other severe personality disorders that is based on psychoanalytic object relations theory. Similar to other psychodynamic psychotherapies, TFP focuses on changing psychological structures, but also focuses on symptom and behavioral change, particul...
Article
This study examines psychopathology and clinical characteristics of patients with borderline personality disorder (BPD) and comorbid narcissistic personality disorder (NPD) from two international randomized controlled trials. From a combined sample of 188 patients with BPD, 25 also fulfilled criteria for a comorbid diagnosis of NPD according to DSM...
Chapter
Full-text available
Personality disorder not otherwise specified (PDNOS) is a diagnostic category describing problems with inter and intrapersonal functioning (i.e., personality disorder) that are not accounted for by the specific personality disorder diagnoses defined by the DSM and ICD.
Chapter
Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research combining the results from a randomized clinical trial (RCT); the results of richly and qualitatively detailed systematic case studies involvi...
Chapter
Full-text available
Personality disorders are a heterogeneous group of mental disorders which arise when an individual’s personality is considered impaired and maladaptive. As will be discussed in greater detail below, personality disorders (PDs) are highly prevalent in the general population (up to 18%) and much higher in patient populations (up to 75%). In addition...
Article
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Objective: We differentiated two hypothesized client subtypes: (a) Pseudosecure clients have high Client Attachment to Therapist Scale (CATS) Secure and high CATS Preoccupied scores, tend to idealize their therapist, and exhibit maladaptive dependency; (b) Individuated-secure clients combine high Secure with low Preoccupied scores and function mor...
Article
Full-text available
Patients with personality disorders (PDs) represent a particular burden for the health system and the clinicians attempting to treat them. The current commentary complements reviews of outcome studies on treatments for PDs by focusing on the clinical utility as defined by the American Psychological Association. As such, extending that notion, clini...
Article
AimBorderline personality disorder (BPD) is characterized by self-regulation deficits, including impulsivity and affective lability. Transference-Focused Psychotherapy (TFP) is an evidence-based treatment proven to reduce symptoms across multiple cognitive-emotional domains in BPD. This pilot study aims to investigate neural activation associated w...
Conference Paper
Full-text available
The Client Attachment to Therapist Scale (CATS) assesses three dimensions of attachment between client and therapist: Secure, Avoidant, and Preoccupied. Clients with high Preoccupied scores tend to exhibit a maladaptive dependency on their therapist. The tendency of some of these clients to simultaneously idealize their therapist while they fear ab...
Article
Full-text available
Individuals with borderline personality disorder (BPD) display an impoverished sense of self and representations of self and others that shift between positive and negative poles. However, little research has investigated the nature of representational disturbance in BPD. The present study takes a multimodal approach. A card sort task was used to i...
Article
Full-text available
In this paper we propose that John Bowlby's attachment theory provides a theoretically coherent, empirically based, and clinically useful model for understanding personality pathology. This theoretical framework brings parsimony and breadth to the conceptualization of the etiology, maintenance, and treatment of personality disorders (PDs). Attachme...
Article
Full-text available
Personality disorders are highly prevalent, associated with considerable morbidity, and difficult to treat. Intrapersonal and interpersonal difficulties are central to the pathology observed in personality disorders. Attachment theory provides a broad yet parsimonious explanatory framework for understanding the development, maintenance, and treatme...
Article
Full-text available
Despite the articulation and growing evidence for shared properties in effective psychotherapies and the value of integrated protocols, the training and the provision of psychotherapy are becoming increasingly monothetic. This movement toward monocultures is in contrast to the development of a comprehensive and integrative theory of psychotherapy t...
Article
We investigated attachment representations and the capacity for mentalization in a sample of adult female borderline patients with and without comorbid narcissistic personality disorder (NPD). Participants were 22 borderline patients diagnosed with comorbid NPD (NPD/BPD) and 129 BPD patients without NPD (BPD) from 2 randomized clinical trials. Atta...
Article
Full-text available
Abstract The growing number of individuals seeking treatment for mental disorders calls for intelligent and responsible decisions in health care politics. However, the current relative decrease in reimbursement of effective psychotherapy approaches occurring in the context of an increase in prescription of psychotropic medication lacks a scientific...
Article
Research has consistently found high rates of comorbidity between narcissistic personality disorder (NPD) and borderline personality disorder (BPD). Patients with this complex clinical presentation often present formidable challenges for clinicians, such as intense devaluation, entitlement, and exploitation. However, there is a significant gap in t...
Article
Full-text available
Borderline personality disorder (BPD) and major depressive disorder (MDD) share numerous features, including dysphoric affect, irritability, suicidality, and a heightened sensitivity to perceived interpersonal rejection. However, these disorders are associated with divergent profiles of reactivity to rejection: Individuals with MDD are more likely...
Article
To characterize predominant typologies of co-occurring personality disorders among adults with posttraumatic stress disorder (PTSD) and examine their relation to Axis I comorbidities, health-related quality of life, and course and treatment of PTSD. Latent class analysis was conducted on the 10 DSM-IV personality disorders in a nationally represent...
Chapter
Whereas some individuals with personality disorders experience intense desires for emotional closeness, others find emotional closeness difficult and distressing. Regardless, those with personality disorders are often characterized by experiences of loneliness, isolation, and distressing solitude. Despite this phenomenological experience, surprisin...
Article
Full-text available
Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experie...
Article
In this introduction to the JCLP: In Session 69(11) issue on attachment theory and psychotherapy, the key points of attachment theory (Bowlby, , , 1981) and its relevance to psychotherapy are briefly described. The aim of this issue is to provide case illustrations of how an attachment theory perspective and principles can expand our understanding...
Article
Full-text available
Transference-Focused Psychotherapy (TFP) is a manualized evidence-based treatment for borderline and other severe personality disorders that is based on psychoanalytic object relations theory. The treatment contracting/setting the frame, managing countertransference, and the interpretative process are three critical components of TFP. We provide vi...
Article
Full-text available
Abstract This meta-analysis synthesizes research on the relation between patient adult attachment style and patient-rated working alliance. A random-effects model was used to calculate the mean weighted product-moment correlation (r) for 24 studies (12 published in peer-reviewed journals and 12 unpublished doctoral dissertations) of individual outp...
Article
Longitudinal data of psychotherapy theoretical orientations (PTO) for faculty from within clinical psychology programs were analyzed for a period of over two decades. Results from multilevel modeling demonstrated that clinical psychology has moved from a field that was relatively balanced in percentages of faculty from cognitive-behavioral (CBT), p...
Article
Full-text available
Several clinical theories propose that borderline personality disorder (BPD) is characterized by a biologically based affective vulnerability to intense affective experiences and impaired modulation of affective states, which might manifest in high emotional intensity, hyperreactivity, and impaired recovery to baseline. However, few studies have te...
Article
Full-text available
In this commentary I examine conceptual and methodological issues in Dr. Riordan's (2012) presentation of three cases treated using Mitchell's integrative model that combines aspects of Kernberg and Kohut's technical stances in the treatment of narcissism. Riordan proposes that Mitchell's integrative model provides a useful blend of Kernberg's focu...
Article
Full-text available
The impact of pathological narcissism on psychotherapy has seldom been investigated empirically, despite extensive clinical theory proposing that highly narcissistic individuals should be reluctant to engage in treatment and derive smaller benefits from therapy. In this study, we investigate the relationship between scores on the Pathological Narci...
Chapter
Full-text available
Though attachment research today is best conceptualized as integrationist and multidisciplinary, it is important to remember that attachment theory was born out of clinical process. Bowlby [1–3] was first and foremost a psychoanalyst, and he drew from clinical experiences with children and adults to conceptualize his theory. Many of his ideas devel...